Exercise Induced Bronchoconstriction
Key Points
Key Points
- The major trigger for bronchoconstriction in a vulnerable subject is either water loss during periods of high ventilation or the addition of an osmotically active agent.
- Exercise itself is not needed to cause bronchoconstriction, just the creation of a hyperosmolar environment.
- The hyperosmolar environment leads to mast cell degranulation with release of mediators, predominately leukotrienes, but also including histamine, tryptase, and prostaglandins. In addition, eosinophils can also be activated, producing further mediators, including leukotrienes.
- The water content of the inspired air, the level achieved and maintained during exercise, or both are the major determinants of exercise-induced bronchoconstriction (EIB).
- EIB is frequently documented with asthma and reflects insufficient control of underlying asthma.
- Elite athletes have a higher prevalence of EIB than seen in the general population, varying with the intensity of exercise and the environment.
Diagnosis
Diagnos...
...ent (SS)1: In asthmatic patients EI...
...: A diagnosis of EIB should be confirmed b...
...e EIB in elite athletes by using objective...
...rm a standardized bronchoprovocation (exerci...
...s with no current clinical history of a...
...se an indirect graded challenge (eg, man...
SS7: Perform an indirect challenge (eg, e...
...the ventilation reached and sustained duri...
...VH as the preferred surrogate challenge for the a...
...n indirect graded challenge (eg, mannitol) result...
...To differentiate between EIB and exe...
...To determine whether exercise-induced d...
...erform spirometry, as well as detailed pulmon...
...er a diagnosis of exercise-induced anaphyla...
Treatment
Treatmen...
...r to appropriate specialists (eg, ca...
...tients for psychological evaluation when the sympt...
...regular office visits with patients beca...
...nergic Receptor Agonists...
...Prescribe inhaled short-acting β...
...cribe a single dose of SABA, LABA, or both on an...
...autious in daily use of β2-adrenergi...
Leukotriene Inhibi...
...: Consider prescribing daily therapy with le...
...ell Stabilizers...
...: Consider prescribing inhaled cro...
ICS...
...r prescribing ICSs in combination wi...
...4: Do NOT prescribe daily LABAs with I...
...icholinergic Age...
...Consider prescribing inhaled ipratropium brom...
...harmacologic Therap...
...be pre-exercise warm-up for EIB because it can...
...ider with caution the recommendation of red...
...e and Elite Athletes
...letes with EIB alone in a similar manner...
...lgorithm for the Diagnosis, Treatment, and Differe...